Preemie nutrition: Study advises on automated tool to calculate nutritional needs

05 Sep 2018 --- Researchers are advising that an automated tool is developed to rapidly calculate nutritional intake for extremely premature babies – preemies – during the transition from intravenous nutrition (IV feeds) to enteral nutrition (feeds through the gut).

Preemies – weighing just over two pounds at birth on average – start out receiving nutrition intravenously. In the first few days or week, they move on to enteral feeds. During this transition, preemies are fed through a mixture of methods, but the total protein intake tends to drop, which interferes with growth.

“Growth and nutrition are essential for premature babies since as they get bigger, they generally require less intervention,” says Gustave Falciglia, MD, MSc, Lead Author and Neonatologist at Ann & Robert H. Lurie Children's Hospital of Chicago and Assistant Professor of Neonatal-Perinatal Medicine at Northwestern University Feinberg School of Medicine. “Our study provides important information to help neonatologists assess the total nutritional effects of their combined orders as they gradually decrease intravenous nutrition and increase enteral feeds.”

Currently used electronic health records do not calculate the total nutrition babies receive from various nutritional delivery practices during the transition to full enteral feeds. Managing optimal nutrition during the transition is a complex process and the study, published in Pediatrics, suggests that an automated system is needed to help clinicians weigh the tradeoffs in calorie and protein intake with different nutrition delivery practice decisions.

“Ultimately, we would like to develop an automated tool to provide immediate feedback on the calories and protein the baby is getting through multiple vehicles used to deliver nutrition during the transitional stages,” says Dr. Falciglia. “This would substantially help clinicians optimize nutrition and growth in very low birth weight infants.”

The advice is based on a retrospective analysis of detailed nutritional and fluid data received by 115 very low birth weight infants over 4,643 days at Lurie Children's regional neonatal intensive care unit (NICU). The median gestational age was 28 weeks and median birth weight was 1,060 grams. 

Changes in calories and protein intake were estimated during five transition phases from full IV nutrition to full enteral nutrition. In each phase, researchers determined the effects of nutrition delivery practices including intravenous nutrition, intravenous lipids, central line, feeding fortification, fluid restriction and excess non-nutritive fluid intake.

Based on their findings, the authors recommend specific approaches to maximize calorie and protein intake during various transition phases.

NutritionInsight has recently reported from this year’s European Society for Clinical Nutrition and Metabolism (ESPEN) Congress in Madrid, Spain. A key theme that arose was the need for more personalized nutrition plans that take into account the different needs and stages of patients. With preemies, this need is particularly salient.